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IPT: Endocrine > Block 1 > Flashcards

Block 1 Flashcards

1
Q

For pregnant women, what Rx should you give for hyperthyroidism?

A

Start w/ PTU for the first trimester, then use MMI for the remainder of pregnancy

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2
Q

Low probability of HPA suppression include…

A

Any dose for less than 3 wks Prednisone alternating day regimen ≤10mg QOD

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3
Q

Mitotane AE?

A

Teratogenic (stored in fat for up to 5 yrs) Induces CYP3A4

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4
Q

When should you choose dopamine agonists initially for pituitary issues?

A
  1. Poor 2. Inability to handle inj. 3. IGF-1 values only modestly elevated and mild signs/symptoms
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5
Q

What are some counseling points on radioactive iodine?

A
  1. Do NOT exchange saliva for 5 days 2. AVOID contact with youngling and pregnant women for 5 days 3. NO breast-feeding 4. Flush toilet twice
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6
Q

What are some pros of GH receptor antagonist for pituitary issues?

A

Most effective at normalization of just IGF-1

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7
Q

When can you use iodides during the time you’re taking taking radioactive iodine?

A

3-7 days AFTER

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8
Q

What is the function of oxytocin?

A

Contract smooth muscles in breast during lactation and plays a role in uterine contraction during parturition

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9
Q

Pegvisomant should be based on (GH/IGF-1) values

A

IGF-1 values

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10
Q

Which beta blockers can partially block the conversion of T4 to T3?

A

Propranolol Nadolol Metoprolol

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11
Q

What is the first line Tx for Bilateral Primary Aldosteronism? Lifestyle modifications?

A
  1. Aldosterone antagonist (like spironolactone) 2. Potassium-sparing diuretic (like Amiloride) Surgery is TOC for unilateral Limit Na+ <100mEq/day, avoid EtOH
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12
Q

Primary adrenocortical insufficiency differs from secondary by…?

A

Primary = destruction of adrenal gland Secondary = hormonal regulation

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13
Q

Radioactive Iodine Uptake test is contraindicated in whom?

A

Pregnant or breastfeeding patients

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14
Q

Which hypercortisolism condition allows for any pharmacologic therapy option?

A

Cushing’s Disease You can use block and replace, normalization, steroidogenesis inhibitors, adrenolytics, pituitary-targeted** **only one with this Rx group

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15
Q

Pharmacodynamics of GH?

A

*Stimulates Liver *Produces insulin-like growth factors *Increase protein levels *Increase release of FA from fat tissues *Increase conversion of FA to acetyl-CoA for energy *ELEVATES BLOOD GLUCOSE Overall effect: encourage burning of fat for energy and increase muscle/bone growth

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16
Q

No doses of glucocorticoids should be given to a patient within _____ hrs within bedtime

A

4 to 6 hrs

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17
Q

What is the only GH receptor antagonist?

A

Pegvisomant (Somavert)

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18
Q

When should you consider checking your GH levels when on Somatostatin LAR?

A

3 months

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19
Q

What is Type I and II hyperthyroidism?

A

I = occurs to those w/ underlying risk factors for thyroid disease II = results form destruction of thyroid which releases thyroid hormones

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20
Q

AE of Pegvisomant (Somavert)?

A

Hypoglycemia, N/V, Increased LFTs, Flu-like symptoms

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21
Q

What are some side effect due to doses of >7.5mg/day of prednisone or equivalent?

A

CV issues Monitor by having a lipid panel after 1 month and then every 6 to 12 months

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22
Q

What is therapeutic use of Etomidate?

A

FDA approved = for anesthesia Off-label = rapid control of hypercortisolism at 0.3mg/kg/hr

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23
Q

If dopamine agonists activate dopamine D2 receptors in the substantia nigra, what happens?

A

Relieves symptoms of Parkinson’s Disease

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24
Q

How is GH dosed and given?

A

QD SubQ 25-50mcg/kg monthly or every 2 wks @ bedtime

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25
Q

Iodine deficiency is called…

A

Goitrous hypothyroidism

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26
Q

What are the basic steps into the ACTH Stimulation Test?

A

To detect primary or secondary adrenal insufficiency 1. Draw plasma cortisol at 8 2. Give Cosyntropin 250mcg IM or IV 3. Check cortisol at 30 min and 60 min 4. Cortisol >18 = normal, No change = Addison’s

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27
Q

What are some cons to GH receptor antagonist for pituitary issues?

A

Expensive and is an injection

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28
Q

What are the monitoring for all patients on Recombinant GH?

A

Thyroid function, glucose, IGF-1, lipid panel Height, weight, BMI

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29
Q

What are some other causes for hyperprolactinemia?

A

*CNS lesions *Increase in TRH in hypothyroidism *Renal/hepatic impairment

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30
Q

AE of dopamine agonists?

A

GI effects, CNS effects, hypotension

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31
Q

Onset for hyperthyroidism Thiourea? Iodides? Adrenergic blockers?

A

Wks Days Hours

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32
Q

Which Rx for aldosteronism is contraindicated if CrCl <30?

A

Eplerenone

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33
Q

What are some indications of d/c corticosteroids?

A

Steroid-induced psychosis unresponsive to antipsychotics Herpes virus-induced corneal ulceration (lead to blindness)

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34
Q

What kind of substrate is Bromocriptine?

A

CYP3A4; dont mix with CYP3A4 inhibitors

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35
Q

When should you choose somatostatin analogs initially for pituitary issues?

A

Moderate - severe disease First, Octreotide Use Lanreotide if refractory to octreotide and pasireotide if refractory to both

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36
Q

When is surgery the treatment of choice for Cushing’s Syndrome? What kind of surgery will they need?

A

When it is Non-iatrogeneic (not caused by surgery or Rx) Unilateral adrenalectomy Transsphenoidal surgery = disease only, not syndrome

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37
Q

If you suspect Cushing’s Syndrome, what should you do? When should you administer RX and draw serum levels? What do you test for if abnormal?

A

24-hr cortisol collection, midnight salivary cortisol level, 1 mg of dexamethasone overnight Give RX @ 11pm to 12am Draw serum cortisol at 8am Cortisol <1.8 = normal 1.8 to 5mcg/dL = likely abnormal >5 = abnormal If abnormal, test for plasma ACTH Low = ACTH-independent Normal/High = ACTH-dependent and must have inferior petrosal sinus sampling Central>peripheral = pituitary tumor Central

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38
Q

Somatostatin is released by what?

A

Hypothalamus and pancreas

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39
Q

When should you consider checking your GH levels when on Somatostatin IR?

A

1 month

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40
Q

What kind of RX should you not take with Bromocriptine?

A

Ritonavir, Indinavir, Ketoconazole, Itraconazole, Clarithyromycin

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41
Q

What hormones are produced in the adrenal cortex?

A
  1. Glucocorticoids 2. Androgen precursors 3. Mineralocorticoids
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42
Q

What enzyme oxidizes iodide?

A

Thyroid peroxidase

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43
Q

High probability of HPA suppression include..

A

Prednisone >20mg/day for 3+ wks Bedtime prednisone 5mg/day for 2+ wks Cushingoid appreanace

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44
Q

What are the 2nd-Gen alpha adrenergic antagonists for BPH and their initial/usual dose?

A
  1. Alfuzosin (10 and 10) 2. Doxazosin (1 IR and 8 /// 4 ER and 4 to 8) 3. Terazosin (1 and 10-20) 4. Prazosin (0.5 and 1-5)
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45
Q

Of the steroidogenesis inhibitors for Cushing’s, which one has a rapid onset?

A

Etomidate (IV) and Metyrapone Ketoconazole is the slowest

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46
Q

What parts make up monoiodotyrosine (MIT) and diiodotyrosine (DIT)?

A

Oxidized iodide + Thyroglobulin

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47
Q

What is a typical manner in which GH is secreted?

A

In a pulsatile manner Low during waking hours and peaks in the first 1-2 hours of sleep Increases after meals, exercise or periods of stress

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48
Q

What are some contraindications for dopamine agonists?

A

Valvulopathy, Ischemic heart disease, peripheral vascular disease, uncontrolled HTN

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49
Q

Which Rx for hypercortisolism is a prodrug?

A

Mitotane

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50
Q

What is the Wolff-Chaikoff Effect?

A

Excessive Iodide (I-) blocks the thyroid function (synthesis and release)

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51
Q

How is BPH ranked in regards to severity?

A

Mild - AUA ≤7 - asymptomatic, peak urine flow <10, PVR volume >25-50ml Moderate - AUA 8 to 19, above + LUTS Severe ≥20, above + one or more BPH complication

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52
Q

Which dopamine agonist is used for Hyperprolactinemia?

A

Bromocriptine (Parlodel®) Cabergoline (Dostinex®)

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53
Q

What are the equivalent doses for hydrocortisone, prednisone, and methylprednisolone?

A

Hydrocortisone - 20mg Prednisone - 5mg Methylprednisolone - 4mg

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54
Q

Before tapering steroids, what could you do beforehand? How would you taper it?

A

Switch to a shorter-acting agent Taper by 10-20% of total daily dose every 1-2 weeks (not to exceed 5mg reduction)

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55
Q

Propylthiouracil MOA?

A

Inhibits peroxidase and blocks synthesis of T3 and T4 Also blocks peripheral conversion of T4 to T3

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56
Q

What are some cons of using dopamine agonists for pituitary issues?

A

Not always efficacious

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57
Q

Contraindication of PDE-5 inhibitors?

A

Nitrate medications; risk of hypotension

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58
Q

If you inhibit CYP11A1, you block the synthesis of what?

A

Cortisol, androgen, and aldosterone

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59
Q

How is Levothyroxine initially dosed?

A

1.6 to 1.7 mcg/kg/day

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60
Q

What are the IGF-1 Rx?

A

Mecasermin + Mecasermin rinfabate

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61
Q

What are some side effects due to prolonged dose (1-2 months) or high dose?

A

Iatrogenic Cushing’s Syndrome; weight gain

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62
Q

What are some lab tests of excess GH?

A

GH >1 mcg/L and elevated IGF-1 levels

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63
Q

Endocrine Society recommends what in regards to combination therapy for pituitary issues?

A

Add pegvisomant or cabergoline in pts w/ inadequate response to a somatostatin analog

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64
Q

What are some AE of the 3rd Gen alpha adrenergic antagonists for BPH?

A

Silodosin - needs to be renally adjusted (CrCl <30), ejaculatory disorders Tamsulosin - do not crush, floppy iris syndrome, sulfa allergy Both need to be taken 30 min before meals

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65
Q

What are the prostaglandin E1 Rx for ED?

A

Alprostadil Injection or urethral suppository Used also as a diagnostic test for ED

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66
Q

What are the basic classes used for Acromegaly?

A
  1. Somatostatin analogs 2. GH receptor antagonist 3. Dopamine agonist
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67
Q

What are the 3rd-Gen alpha adrenergic antagonists for BPH and their initial/usual dose?

A
  1. Silodosin (8) 2. Tamsulosin (0.4, maybe 0.8)
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68
Q

Cleavage of angiotensinogen to angiotensin I occurs where?

A

Liver

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69
Q

What is a regular prolactin level in non-pregnant females?

A

<25mcg/L

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70
Q

What RX can cause GH deficiency?

A

Glucocorticoids Methylphenidate Dextroamphetamine

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71
Q

How is Mecasermin dosed ?

A

BID SubQ +/- 20min of a meal

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72
Q

Which dopamine agonist is used for Parkinson’s?

A

Bromocriptine (Parlodel®)

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73
Q

What are the RX classes used for Cushing’s Syndrome?

A
  1. Steroidogenesis inhibitors 2. Pituitary targeted therapy 3. Glucocorticoid receptor antagonist 4. Adrenolytic agent
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74
Q

Primary Adrenocortical Insufficiency is also known as…?

A

Addison’s Disease

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75
Q

How is Levothyroxine titrated?

A

25mg increments q6-8wks Check TSH 6-8wks after each dose change

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76
Q

How is the thyroid hormone regulated?

A

Hypothalamus produces TRH which stimulates the anterior pituitary to make TSH which allows the thyroid gland to produce thyroid hormones TSH inhibits the hypothalamus Thyroid hormones inhibit both hypothalamus and anterior pituitary

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77
Q

Propylthiouracil vs Methimazole, which is longer acting?

A

Methimazole

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78
Q

What CYP protein does Ketoconazole inhibit?

A

CYP17 Higher dose = CYP11A1

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79
Q

When is prednisolone give over hydrocortisone for glucocorticoid replacement?

A

Pts w/ poor compliance. It is given 3-5mg ONCE daily compared to 15-25mg/day divided BID or TID

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80
Q

Use of Pasireotide?

A

Cushing’s Disease + Acromegaly

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81
Q

The most important pharmacotherapy plan in treating aldosteronism is…?

A

**Titrating dose to normal K+** Monitor K+ every 4wks and monitor BP daily

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82
Q

Primary hyperaldosteronism is also known as…

A

Conn’s Disease

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83
Q

What are some AE of Thiourea Rx?

A

Rash, GI problems, hepatotoxicity (worse with propylthiouracil)

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84
Q

What kind of neurotransmitter effect does Cushing’s Syndrome have?

A

Depression

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85
Q

What effect does Dopamine have on the anterior pituitary?

A

Inhibits PRL (prolactin)

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86
Q

What hormones do the anterior pituitary gland produce?

A

Growth hormone (somatotropin) Prolactin ACTH TSH FSH LH

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87
Q

What CYP protein does Etomidate inhibit?

A

CYP11B1 Same as Metyrapone

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88
Q

What is Adrenal Crisis?

A
  1. Adrenal cortex doesnt respond to stress 2. Cortisol reserves are used up 3. Hypovolemic shock and coma 4. High K+ and Low Na+ and Low BP
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89
Q

What Rx can store in adipose tissue for up to 5 years?

A

Mitotane (Adrenolytic Rx)

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90
Q

Metyrapone AE?

A

Increase androgen production (more acne, hirsutism, counters antiandrogenic effect of Ketoconazole) Increases 11-deoxycortisol

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91
Q

What effect does GHRH have on the anterior pituitary?

A

Promotes GH (growth)

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92
Q

What are the RX classes used for hyperaldosteronism?

A
  1. Aldosterone receptor antagonists 2. K-sparing diuretic
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93
Q

Subclinical hyperthyroidism TSH T3/T4 TSI RIUT

A

TSH = down T3/T4 = normal TSI = - RIUT = - Not an autoimmune disorder, so TSI = -. Normal T3/T4 = RIUT is -

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94
Q

What is the clinical presentation of Primary Aldosteronism?

A
  1. High BP 2. Hypokalemia 3. Metabolic alkalosis 4. Edema 5. Muscle weakness
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95
Q

What cleaves angiotensin I to II?

A

ACE

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96
Q

AE of Lanreotide?

A

N/D, stomach problems Gallstones

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97
Q

Anticholinergic agent AE?

A

Anti-SLUD Dry mouth, dry eyes, confusion, dilated pupils, urinary retention

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98
Q

Spironolactone AE?

A

Androgen antagonist Progesterone agonist Hyperkalemia, heart issues, gynecomastia

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99
Q

With hyperprolactinemia, how does that affect the hypothalamus?

A

Positive effect

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100
Q

What are the steroidogenesis inhibitor RX used for Cushing’s Disease?

A
  1. Ketoconazole 2. Metyrapone 3. Etomidate 4. Aminoglutethimide ***1-3 are not FDA approved for Cushing’s
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101
Q

What are some drug interactions with Recombinant GH?

A

Corticosteroids Estrogen Antidiabetic agents

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102
Q

Most common hypothyroid state in the US is called…

A

Hashimoto’s Thyroiditis

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103
Q

Coupling of DIT and DIT form (T3/T4)

A

T4

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104
Q

What is the difference between micro and macroadenomas?

A

Micro = <10mm in diameter and do not increase in size Macro = >10mm in diameter and will continue to grow and invade other tissues

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105
Q

How is thyroglobulin secreted?

A

From the ER of a thyroid follicle cell

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106
Q

What are the main classes to help with BPH?

A
  1. Alpha-antagonists (relax prostatic muscle) 2. Phosphodiesterase inhibitors (see above) 3. 5-alpha-reductase inhibitors (decrease testosterone effect) 4. Anticholinergic agents (relax detrusor muscle)
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107
Q

How does Alprostadil work?

A
  1. Activate prostaglandin receptor 2. Decrease Ca influx 3. Relaxation of smooth muscle 4. Erection
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108
Q

______ production in substantia nigra is reduced in Parkinsons

A

Dopamine

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109
Q

What pharmacologic therapy options exist for ectopic ACTH or CRH secreting tumors?

A

Steroidogenesis inhibitors + adrenolytics

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110
Q

What is used to retard the release of T3 and T4 during a thyroid storm?

A

KI (Lugol’s solution)

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111
Q

Etomidate AE?

A

Venous pain + skeletal muscle movements

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112
Q

What is more effective for prolactinomas, Transsphenoidal surgery or dopamine agonists?

A

Dopamine agonists

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113
Q

What are some non-pharmacologic diet Tx of BPH?

A

Low fat, high intake of fruits + veggies

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114
Q

Normal range of TT3?

A

60 to 181 ng/dL

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115
Q

What do recombinant GH hormone products contain?

A

Somatropin; same AA sequence in human GH

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116
Q

What are some metabolic changes in pregnancy + thyroid?

A

Increases estrogen = higher levels of thyroxine binding globulin which increases transport of thyroid hormones Increase of iodine requirements to 200 to 300mcg/day

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117
Q

Which RX group does not affect GH production and therefore does not decrease tumor size?

A

GH receptor antagonist (Pegvisomant)

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118
Q

What are some side effects due to prolonged dose (6-12 months) or high dose?

A

Osteoporosis Take calcium 1000-1500mg/day + vit D (800IU/day) Regular DEXA/FRAX testing

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119
Q

What are the AE of the PDE-5 inhibitors?

A

All = headache, flushing, nasal congestion, dyspepsia Just Sildenafil (Viagra) = altered or bluish vision

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120
Q

PDE-5 inhibitor and Onset/Duration?

A

All but Tadalafil Onset = 1hr (Avanafil = 0.5hr) Duration = 4hr Tadalafil Onset = 2-12hr Duration = 24-36hr

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121
Q

How does Secondary Aldosteronism differ from Primary?

A

Increase in Renin production which leads to a bunch of CV issues

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122
Q

What are the main clinical presentations for BPH?

A

2 major symptoms: obstructive and irritative

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123
Q

What effect does CRH have on the anterior pituitary?

A

Promotes ACTH (Adrenocorticotropic)

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124
Q

How is somatostatin IR and LAR given?

A

IR = SubQ LAR = IM

125
Q

The adrenal cortex produces what class of corticosteroid hormones?

A
  1. Glucocorticoids 2. Adrenal androgen precursors (EX: DHEA) 3. Mineralocorticoids
126
Q

What are some clinical issues associated with excess GH?

A
  1. Cardiovascular issues 2. Joint issues 3. Respiratory disorders and sleep apnea 4. T2DM 5. GI cancers
127
Q

Normal range of TSH?

A

0.5 to 4.7

128
Q

What are some signs and symptoms of hyperprolactinemia in males?

A

Amenorrhea, galactorrhea, infertility

129
Q

When is initiation of recombinant GH started in children?

A

Prior to puberty is most favorable

130
Q

What are some signs of excess GH?

A
  1. Coarsening of facial features 2. Increased hand volume, ring size, shoe size 3. Enlarged tongue 4. Various skin conditions
131
Q

What is the Tx goal of Recombinant GH in adults?

A

Increase muscle mass and reduce adiposity

132
Q

What are some pros of somatostatin analogs for pituitary issues?

A

More effective vs dopamine agonists at normalization of GH AND IGF-1

133
Q

What are some side effects due to doses of >15mg/day of prednisone or equivalent?

A

HPA Axis Suppression Prevent this by tapering the dose down

134
Q

Propylthiouracil vs Methimazole, which can cause hypoglycemia?

A

Methimazole

135
Q

What is the only pregnancy category C Rx for pituitary gland issues?

A

Mecasermin (Increlex®)

136
Q

When is radiation therapy for someone with excess GH?

A

Poor surgical candidates or those who refuse it

137
Q

What are some considerations when giving a mineralocorticoid?

A

Adjust dose for summertime dosing

138
Q

What kind of class is Macimorelin (Macrilen)?

A

Ghrelin agonist (GH secretagogue agonist)

139
Q

When monitoring for hypercortisolism with Mitotane, what should you look for?

A

Urine free cortisol because of increase of presence of cortisol binding globulin which falsely increases cortisol levels and decreases efficacy of hydrocortisone

140
Q

IV use of Octreotide is used for what?

A

Acromegaly or tumor Tx

141
Q

Physiology of erection

A
  1. Neurons reach tissue via cavernosal nerve 2. Relaxation of arterioles and trabecular smooth muscles 3. Pooling of blood in sinusoidal space 4. Compression of subtunical venous plexuses, increasing pressure 5. Length and diameter increase
142
Q

Could you use IGF-1 Rx to replace a GH Rx?

A

No

143
Q

Bilateral adrenalectomy is reserved for what?

A

Last resort and only for ACTH-secreting disease. Will need lifelong glucocorticoid and mineralocorticoid replacement

144
Q

What is a counseling point for Levothyroxine?

A

Take Rx on an empty stomach 30 min to 1 hr before breakfast or at bedtime 4 hrs after evening meal

145
Q

What are some AE of Bromocriptine?

A

Hallucinations Impulse control Orthostatic hypotension

146
Q

Intermediate probability of HPA suppression include…

A

Prednisone 10-20mg for 3+ wks Prednisione <10mg/day

147
Q

Angiotensinogen is cleaved in the liver to…

A

angiotensin I

148
Q

Which corticosteroids have the highest anti-inflammatory properties?

A

Dexamethasone (highest) and fludrocortisone

149
Q

How is Lanreotide given?

A

SubQ in da butt

150
Q

What is the new RX to test for GH deficiency?

A

Macimorelin (Macrilen)

151
Q

What Rx decreases T4 absorption?

A

Multivitamins, cholestyramine, and sucralfate

152
Q

What Rx interacts w/ levothyroxine?

A

Warfarin + Digoxin

153
Q

What Rx elevate prolactin levels?

A

*Dopamine agonists (antipsychotics, phenothiazines, Reglan, domperidone) *Verapamil *Prolactin stimulators (hormones, antidepressants, opioids, cocaine)

154
Q

AE of Octreotide?

A

Gallbladder abnormalities, N/D, stomach problems

155
Q

Cushing Syndrome and its major effects?

A
  1. High glucose 2. Central obesity and buffalo hump 3. Immunosuppression 4. High BP, Low K+, Edema 5. Androgen synthesis (acne, infertility, etc) 6. Depression
156
Q

When should you give a steroid to mimic their natural cycle of cortisol?

A

Around 0830

157
Q

MOA of Iodine?

A

Use to treat + detect hyperthyroidism Iodine is taken up by gland and deposited in colloid. Beta and gamma radiation destroys parenchymal cells

158
Q

What are some drug interactions with Octreotide?

A

Cyclosporine, Beta blockers, and calcium channel blockers

159
Q

How long does levothyroxine take to get to steady state?

A

About 6 wks

160
Q

How should you monitor the efficacy for dopamine agonists?

A

Improvements in signs/symptoms and GH <1mcg/L after 4 to 8 wks

161
Q

How is Pasireotide given?

A

IM

162
Q

How does iodide enter the thyroid follicular cell?

A

Through a Na/I- symporter

163
Q

What cells in the pancreas produce somatostatin?

A

Delta cells

164
Q

What is the treatment of choice for most people with excess GH?

A

Transsphenoidal surgical resection

165
Q

Addison’s Disease is also known as…?

A

Primary Adrenocortical Insufficiency

166
Q

How would you initiate which pharmacotherapy strategy to begin with for hypercortisolism?

A
  1. Start with low dose steroidogenesis inhibitor 2. Titrate until normal cortisol level 3. High variability = block and replace. Low = normalization Block and replace = begin w/ corticosteroid such as dexamethasone or prednisone, then titrate until cortisol is undetectable Normalization = educate patient on glucocorticoids rescue just in case
167
Q

Dopamine agonists are used for what?

A

Reduce GH production Shorter duration of action when used for hyperprolactinemia

168
Q

What is the only Rx for pituitary issues that is weight-based?

A

Recombinant GH for GH deficiency Recombinant IGF-1 (Mecasermin)

169
Q

How are thyroid hormones synthesised and released?

A

Uptake of I- thru thryoid epithelial cells I- is oxidized and incorporated into tyrosine residues bound to thyroglobulin into MIT and DIT

170
Q

Mitotane take _______ for onset

A

weeks to months

171
Q

What is a regular prolactin level in pregnant females?

A

34-386mcg/L

172
Q

Males vs Females; who is more likely to get excess GH?

A

Equal chance

173
Q

What hormones do the posterior pituitary gland produce?

A

Vasopressin + oxytocin

174
Q

What are the basic classes used for GH deficiency?

A
  1. GH 2. Insulin-like growth factor-1 (IGF-1)
175
Q

Side effects due to Metyrapone cancel out with what RX?

A

Ketoconazole

176
Q

What is a normal serum cortisol level?

A

7-20

177
Q

Methimazole MOA?

A

Inhibits peroxidase and blocks synthesis of T3 and T4, but does NOT inhibit peripheral conversion of T4 to T3

178
Q

How does Somatostatin analogs block GH release?

A

Bind and activate SST2 and SST5 somatostatin receptors

179
Q

Do the drugs for hyperthyroidism block the release of stored hormones?

A

Nope, they take 2 days to 2 wks to deplete stored pool of hormones

180
Q

What are some symptoms of excess GH?

A

Local effects of GH-secreting tumor = headache and visual disturbance Elevated GH and IGF-1 = sweating, neuropathies, joint pain, and paresthesias

181
Q

What are some immediate side effects due to glucocorticoids?

A

Within 1 wk, behavioral and sleep disturbances Hyperglycemia and Hypertension Dose in the AM to prevent sleep issues A1c 48 hrs after initiation then every 3-6 months BP 1-2 days after initiation then regularly afterwards

182
Q

When are iodides given?

A

Adjunctive therapy for preparation on Grave’s disease surgery

183
Q

Growth-promoting effects of GH are mediated by what?

A

IGF-1 = before/after birth IGF-2= in utero

184
Q

When can you use a beta-blocker during the time you’re taking radioactive iodine?

A

Any time

185
Q

Which Rx for aldosteronism is a CYP3A4 substrate?

A

Eplerenone

186
Q

How does amiodarone cause hypothyroidism?

A

Occurs anytime and is NOT dose-related

187
Q

When should Recombinant GH be administered?

A

In the evening

188
Q

What are the basic classes used for hyperprolactinemia?

A
  1. Dopamine agonists
189
Q

Pathophysiology of Grave’s Disease

A

Continuous stimulation of thyroid gland via Thyroid stimulating antibodies (TSABs) Pituitary TSH secretion is suppressed due to too many thyroid hormones

190
Q

What are some lab tests for GH deficiency?

A

GH <10mcg/L during a 2 hr period following a GH provocation test Physical height is >2 standard deviations below population mean for given age/sex

191
Q

When beginning surgery for Cushing’s Syndrome, what Rx will they need for the week?

A

Glucocorticoid on operative day Mineralocorticoid 5 days after operation Continue Tx until cortisol >20

192
Q

Posterior pituitary gland is known as (Adenohypophysis//Neurohypophysis)

A

Neurohypophysis

193
Q

When monitoring for hypercortisolism with Mifepristone, what should you look for?

A

Clinical signs rather than lab values

194
Q

What are some pharmacological means to induce smooth muscle relaxation?

A
  1. Activate K channel (hyper polarize) 2. Inhibit Ca channel 3. Decrease MLC phosphorylation 4. Increase cGMP (does all of the above)
195
Q

Fludrocortisone has only (glucocorticoid.mineralocorticoid) effects

A

Mineralocorticoid

196
Q

What are the 5-alpha reductase inhibitors for BPH?

A
  1. Finasteride (inhibits type II) 2. Dutasteride (inhibits type I and II)
197
Q

400mg of amiodarone releases ____mg of iodine

A

12

198
Q

AE of Pasireotide?

A

Hyperglycemia, Diarrhea, Gallstones

199
Q

What is the most common cause of Cushing’s Syndrome?

A

Glucocorticoid use

200
Q

In regards to dose, what is something to look out for in recombinant GH for GH deficiency?

A

Potency is expressed as 1 mg = 2.6 IU of GH

201
Q

When are peeps usually diagnosed with excess GH?

A

Middle aged

202
Q

When should you administer Macimorelin (Macrilen)?

A

After 8 hours of fasting

203
Q

PDE-5 inhibitors and CV effects?

A

All lower BP by 5mmHg; no clinical significance even to those w/ cardiac disease

204
Q

When should you choose GH receptor antagonists initially for pituitary issues?

A

High IGF-1 levels and refractory to somatostatin analogs.

205
Q

What is the Tx goal of Recombinant GH in kids?

A

Achieve normal adult height

206
Q

What pharmacologic therapy options exist for adrenal adenoma/carcinoma?

A

Adenoma = either block and replace or normalization Carcinoma = only palliative normalization Steroidogenesis inhibitors Adrenolytics only if there is an inoperable adrenal carcinoma

207
Q

What should you do if growth rate is less than 2-2.5cm/year when treating with recombinant GH?

A

Non-responders will get doubled the normal dose If no response from that, d/c therapy

208
Q

What are some other uses of Sildenafil (Revatio) and Tadalafil (Adcirca)?

A

Pulmonary Arterial HTN

209
Q

What is the function of vasopressin?

A

Antidiuretic hormone; acts on collecting ducts to conserve water

210
Q

How would you Tx symptomatic prolactinomas?

A
  1. Dopamine agonist 2. Transsphenoidal surgery 3. Radiation w/ surgery
211
Q

PDE-5 inhibitors and food?

A

High fat meals will slow down absorption except with Tadalafil Metabolized via CYP3A4

212
Q

What are some symptoms of glucocorticoid withdrawal?

A

Flu-like symptoms Disease flare Mild symptoms? Give supplemental hydrocortisone Severe? Treat as adrenal crisis

213
Q

What effect does SRIF have on the anterior pituitary?

A

Inhibits TSH (thyroid) + inhibits GH (growth)

214
Q

AE of IGF-1 Rx?

A

Hypoglycemia

215
Q

What is the difference between Cushing’s Syndrome and Disease?

A

Disease = pituitary tumor that increases ACTH and therefore cortisol as well. CRH is still not produced Syndrome = CRH is not produced, therefore not ACTH and no cortisol

216
Q

What are some monitoring parameters when initiating alpha-adrenergic antagonists for BPH?

A

Hypotension, ejaculation disorder, floppy iris syndrome

217
Q

Anticholinergics can be used for (obstructive/irritative) symptoms

A

Only irritative

218
Q

What is found in Pegvisomant (Somavert)?

A

GH analog w/ PEG

219
Q

What is the overall/specific goal of Tx on BPH?

A
  1. Improve AUA score by at least 3 points 2. Increase urine flow rate 3. Normalization of PVR
220
Q

What are the main Rx that cause drug-induced thyroid disorders?

A

Lithium - hypo Amiodarone - both Interferone - both

221
Q

What are the dopamine agonists?

A

Bromocriptine (Parlodel®) Cabergoline (Dostinex®)

222
Q

How does iodide enter the lumen?

A

Through pendrin

223
Q

Could you use IGF-1 Rx on someone with GH deficiency?

A

No; Not intended for use in subjects with secondary forms of IGF-1 deficiency, such as GH deficiency, malnutrition, hypothyroidism, or chronic treatment with glucocorticoids

224
Q

What are the main causes of GH deficiency?

A

Congenital via gene deletion of developmental disorders Acquired via other conditions such as head trauma, CNS infection, or even RX

225
Q

What are the monitoring parameters of Pegvisomant?

A

Check IGF-1 values every 6-12 months, colonoscopy, and CV risk factors

226
Q

Anterior pituitary gland is known as (Adenohypophysis//Neurohypophysis)

A

Adenohypophysis

227
Q

Which PDE-5 inhibitor is more selective toward PDE-5?

A

Cialis (Tadalafil) + Stendra (Avanafil) Cialis is also more potent at PDE11 vs all PDE5 inhibitors

228
Q

What hormones do the hypothalamus produce?

A

*CRH (corticotropin) *TRH (Thyrotropin) *SRIF (Somatotropin releasing inhibiting factor) *GnRH (Gonadotropin) *Dopamine *GHRH (Growth)

229
Q

What effect does GnRH have on the anterior pituitary?

A

Promotes FSH + LH

230
Q

What is the issue with using testosterone for ED?

A

Does NOT correct it Takes days or weeks to see effects

231
Q

What is the place in therapy for 5-alpha reductase inhibitors for BPH?

A

BPH w/ enlarged prostate gland and elevated PSA Use w/ alpha1-adrenergic antagonist for 6 months before the 5-alpha reductase inhibitors begin to work

232
Q

Subclinical hypothyroidism TSH T3/T4 Antithyroid AB

A

TSH = up T3/T4 = normal Antithyroid AB = -

233
Q

When can you use thin amides be given during the time you’re taking radioactive iodine?

A

Needs to be withdrawn 4 to 6 days before and reinstituted 4 days after radioactive iodine

234
Q

Liothyronine is (T3/T4)

A

T3

235
Q

What are the phosphodiesterase inhibitors used for BPH?

A

Just Tadalafil, however it must be used with an alpha-adrenergic antagonist (make sure to monitor BP for hypotension)

236
Q

Eplerenone AE?

A

No effect on androgen and progesterone receptors like spironolactone Mild hyperkalemia

237
Q

What are the Rx interactions with propylthiouracil and methimazole?

A

Anti-Vitamin K activity may increase activity of warfarin Increased clearance of B adrenergic blockers Increase levels of digoxin

238
Q

Which somatostatin analog has a higher incidence of hyperglycemia?

A

Pasireotide

239
Q

If dopamine agonists activate dopamine D2 receptors in the pituitary, what happens?

A

Inhibits prolactin secretion In pts w/ acromegaly, it inhibits GH release

240
Q

What disadvantages to block and replace pharmacotherapy strategy have over normalization?

A

More AE and requires higher dose and multiple agents

241
Q

Pathophysiology of Primary Aldosteronism?

A

AKA Conn’s Disease 1. Aldosterone is secreted by an adrenal adenoma 2. Na+/Water retention 3. Increases BP 4. Decreases Renin 5. Decreases Angiotensin

242
Q

What should you monitor when initiating dopamine agonist therapy for prolactinomas?

A

Check prolactin level every 3 to 4 wks

243
Q

T3 vs T4, which is more potent? Efficacy?

A

Both = T3

244
Q

What is the FDA black box warning for thyroid hormones?

A

Don’t use them alone or with another Rx for weight loss

245
Q

What is the best tolerated and most effective Rx that inhibits steroidogenesis in hypercortisolism?

A

Ketoconazole

246
Q

What is another name for Lugol’s solution?

A

Potassium Iodide

247
Q

Alpha-adrenergic antagonists can be used for (obstructive/irritative) symptoms

A

Bof

248
Q

What is the clinical presentation of Primary Adrenocortical Insufficiency?

A
  1. Hypoglycemia due to decreased cortisol 2. Low BP, Low Na+, High K+ due to decreased aldosterone 3. Skin bronzing due to increased melatonin-stimulating hormone because of up-regulation of ACTH production
249
Q

Which phosphodiesterase enzymes are relevant to the penis?

A

PDE 5 + 11 PDE 6 - retina (AE)

250
Q

What is the 1st line therapy Rx for hyperaldosteronism?

A

Aldosterone receptor antagonists such as spironolactone and eplerenone

251
Q

Explain the pharmacodynamics behind Mifepristone.

A

Progesterone antagonist (terminates early pregnancy) Higher dose = glucocorticoid receptor antagonist which blocks effects of hypercortisolism

252
Q

What disorder can cause skin bronzing?

A

Addison’s Disease

253
Q

What are some AE of Cabergoline?

A

Depression Nasal congestion Increased LFT

254
Q

Levothyroxine is (T3/T4)

A

T4

255
Q

Cortisol activates steroids within what organ? Inactivated where?

A

Liver Kidney inactivates cortisol

256
Q

Could you use IGF-1 Rx on someone with primary IGF-1 deficiency?

A

Yes for primary No for secondary forms

257
Q

AE of GH in children?

A

Intracranial HTN w/ papilledema, visual changes, H/N/V

258
Q

What is the Beer’s Criteria of using Recombinant GH?

A

Avoid use unless it is used as a replacement following pituitary gland removal

259
Q

Which Thiourea RX is first-line for first trimester of pregnancy?

A

Propylthiouracil

260
Q

The dopamine agonists are derived from what?

A

Ergot

261
Q

What drugs are classified as Somatostatin analogs?

A

-reotides Octreotide, Lanreotide, Pasireotide

262
Q

What CYP protein does Metyrapone inhibit?

A

CYP11B1 Same as Etomidate

263
Q

What are some signs and symptoms of hyperprolactinemia in females?

A

Decreased libido, infertility, visual loss

264
Q

What is the first step in determining etiology of hyperthyroidism?

A

Radioactive Iodine Uptake Test

265
Q

How would you Tx drug-induced prolactinomas?

A

*D/c offending agent *Administer therapeutic alternative *If no alternative exists, consider dopamine agonist or sex-steroid replacement

266
Q

What are the 3 main causes of erections?

A
  1. Psychogenic - audiovisual stimuli or fantasy 2. Reflexogenic - tactile stimuli 3. Nocturnal - during REM sleep
267
Q

Ketoconazole AE?

A
  1. Hepatic levels may rise 2. Gynecomastia + hypogonadism in males 3. Teratogenicity 4. Inhibits CYP3A4
268
Q

What is a regular prolactin level in males?

A

<15mcg/L

269
Q

What accounts for >90% of excess GH?

A

GH-secreting pituitary adenoma; BENIGN tumor of epithelial origin

270
Q

What are some pros of using dopamine agonists for pituitary issues?

A

Cheap and oral route

271
Q

When can you use iodides + RAI treatment?

A

Use iodides 3 to 7 days AFTER RAI treatment

272
Q

What is used to block the synthesis of T3 and T4 during a thyroid storm?

A

Propylthiouracil

273
Q

Graves Disease TSH T3/T4 TSI RIUT

A

TSH = down T3/T4 = up TSI = + RIUT = up Autoimmune disorder makes TSI + If T3/T4 go up, RIUT goes up

274
Q

What kind of receptor is a GH receptor?

A

Reception Tyrosine Kinase

275
Q

What Rx increases T4 metabolism?

A

Phenytoin, phenobarbital, rifampin, and sertraline

276
Q

Hashimoto’s disease TSH T3/T4 Antithyroid AB

A

TSH = up T3/T4 = normal or down Antithyroid AB = +

277
Q

What should you monitor on recombinant GH?

A

Blood glucose and BP

278
Q

What are some cons to somatostatin analogs for pituitary issues?

A

Expensive and is an injection

279
Q

Besides suppressing GH release, what other system do Somatostatin analogs affect?

A

Suppresses release of GI hormones (reduce secretion and motility)

280
Q

Androgen replacement is important to whom for Addison’s Disease?

A

Women with depression and libido DHEA 25-50 mg daily in AM for about 6 months

281
Q

GH counteracts the effects of what?

A

Insulin Pts walk in with hyperglycemia due to glycogenolysis and decreased uptake of glucose into muscles

282
Q

Coupling of MIT and DIT form (T3/T4)

A

T3

283
Q

AE of GH in adults?

A

Increased % of diabetes

284
Q

What should you monitor when prolactin levels are reaching normal levels when treating prolactinomas?

A

Check prolactin levels every 6 to 12 months

285
Q

Normal range of FT4?

A

0.8 to 2.7

286
Q

What are the monitoring parameters for kids on Recombinant GH?

A

Growth curve, Tanner staging, bone age every 6 to 12 months **specific for kids only

287
Q

Adenomas are symptomatic prolactinomas that are NOT drug-induced. How would you further classify the adenomas?

A

Macro or Micro

288
Q

How is Mecasermin rinfabate dosed?

A

QD SubQ (morning or evening)

289
Q

What are some AE of the 5-alpha reductase inhibitors for BPH?

A
  1. Takes 6-12 months to show effect 2. More sexual dysfunction vs alpha adrenergic antagonists 3. Pregnancy category X
290
Q

Use of Lanreotide?

A

Gastroenteropancreatic Neuroendocrine Tumors (GEN-NET) + Acromegaly

291
Q

Which dopamine agonist is used for Acromegaly?

A

Bromocriptine (Parlodel®)

292
Q

What are some side effects due to doses of >10mg/day of prednisone or equivalent?

A

Glaucoma Monitor by having regular eye exams

293
Q

What is the regular fasting prolactin level?

A

>25mcg/L

294
Q

Normal range of TT4?

A

4.5 to 10.9

295
Q

What is the black box warning for propylthiouracil?

A

Severe liver injury and acute liver failure have been reported with this Rx Reserve propylthiouracil for those who cant tolerate methimazole

296
Q

Which dopamine agonist is used for Cushing’s Disease?

A

Cabergoline (Dostinex®)

297
Q

Which dopamine agonist is preferred for pregnant women?

A

Bromocriptine Cabergoline has a superior efficacy though

298
Q

What effect does TRH have on the anterior pituitary?

A

Promotes TSH (thyroid)

299
Q

If you inhibit CYP17, you block the synthesis of what?

A

Cortisol and androgen

300
Q

SubQ use of Octreotide is used for what?

A

Acromegaly

301
Q

Which corticosteroid has only mineralocorticoid effects?

A

Fludrocortisone

302
Q

What are the signs of GH deficiency?

A

Reduced growth velocity and delayed skeletal maturation

303
Q

When Angiotensin II binds w/ AT1 receptors, what happens to sodium and potassium?

A

Sodium retention and potassium excretion

304
Q

What is the recommended dose of iodide for adults and pregnant women?

A

150mcg - adults 200mcg - pregnant women

305
Q

What Rx can be useful who pts w/ severe diarrhea due to metastatic carcinoid tumors?

A

Octreotide (helps suppress GI stuff)

306
Q

Which corticosteroids have the highest mineralocorticoid activity with glucocorticoids?

A

Cortisone and Hydrocortisone Both have short duration of action and allows patients to take just 1 pill rather than 2 (like prednisone and fludrocortisone)

307
Q

How should you prevent Adrenal Crisis?

A

There are 2 kinds of conditions 1. Fever/”kinda” sick, ABx use, small outpatient procedure = double oral dose 2. Severe sickness, fasting for procedure, during surgery = hydrocortisone 100mg immediately then 50mg q6hrs. Then 1-3 Liters of D5NS or NS and Tx hyperkalemia as needed

308
Q

Recombinant GH AE?

A

Fluid retention Hyperglycemia Carpal tunnel syndrome

IPT: Endocrine (4 decks)

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